Healthcare Provider Details

I. General information

NPI: 1649661133
Provider Name (Legal Business Name): LAUREN CAMER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W 111TH ST
CHICAGO IL
60655-2715
US

IV. Provider business mailing address

1034 CHEROKEE PL
LEMONT IL
60439-4310
US

V. Phone/Fax

Practice location:
  • Phone: 773-881-0888
  • Fax:
Mailing address:
  • Phone: 773-881-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227015782
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: